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CASE REPORTS
Unusual presentation of a late complication in a polyacrylamide gel-injected breast
Hui-Ling Peng, Yi-Ho Cheng, Yu-Hsien Lin, Chun-Hung Ko
March-April 2017, 50(2):77-80
DOI:10.4103/fjs.fjs_24_17  
Implant migration is a known complication of hydrophilic polyacrylamide gel (PAAG) mammoplasty. We report the case of a female patient with an undisclosed history of bilateral breast augmentation with PAAG injections 10 years ago. The patient presented with abdominal pain and rapid gel migration into the abdominal and pelvic walls after sneezing. Computed tomography and sonography were performed, but the results were inconclusive. The diagnosis of PAAG migration was not made until the patient complained of progressive shrinkage of her right breast and disclosed the history of PAAG mammoplasty. A subsequent magnetic resonance imaging study confirmed the diagnosis. Gel migration was successfully treated using endoscopic lavage and breast debridement. Familiarity with the radiological features of PAAG migration and a thorough examination of the patient's history are mandatory for the accurate diagnosis of this complication.
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Cytomegalovirus infection in a kidney transplantation patient presented with skin lesion
Shun-Kai Chang, Yeong-Chin Jou, Show-Hwa Tong, Yen-Fen Lin, Yu-Ling Kuo, Jia-Fang Wu
May-June 2017, 50(3):114-116
DOI:10.4103/fjs.fjs_38_17  
Cytomegalovirus (CMV) infection commonly occurs after major organ transplantation. It mostly presents gastrointestinal tract symptoms in clinical manifestation. Dermatologic lesion as a main presenting feature for posttransplantation CMV is very rare. Here, we report a case of CMV infection predominated by skin ulcers in genitalia and perianal area in a 59-year-old female who received renal transplantation 3 months ago. She had initially been treated with both oral and topical antibiotics for suspicious bacterial or fungus infection without response. Subsequent serological study proved positive CMV infection. After treatment of ganciclovir and valganciclovir for 2 weeks, respectively, the skin ulcers healed gradually. This case report suggests that CMV-induced skin infection should be concerned in the diagnosis of poor healing skin ulcers in patients received organ transplantation.
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ORIGINAL ARTICLES
Arterial lactate level is associated with mortality rate in unscheduled surgical intensive care admissions
Min-Hsin Huang, Chao-Han Lai, Ping-I Lin, Wu-Wei Lai
January-February 2017, 50(1):21-27
DOI:10.4103/fjs.fjs_8_17  
Background: Lactate is a widely used biomarker for patients with conditions such as infection or trauma. The value of lactate level in risk stratification is rarely investigated for patients admitted to the surgical Intensive Care Unit (ICU), regardless of diagnosis. Purposes: This study examines whether arterial lactate levels at the approximate time of admission can predict short-term mortality in all unscheduled surgical ICU patients. Materials and Methods: A retrospective cohort study of all unscheduled surgical ICU admissions from July 2010 to June 2013 was conducted. Patients were stratified into low (<2.0 mmol/L), intermediate (2.0–3.9 mmol/L), and high (≥4.0 mmol/L) lactate groups according to initial lactate measurements. The primary endpoint was 28-day mortality. Results: Of 1404 eligible admissions, 163 (11.6%) of them died within 28 days. Admission lactate levels were significantly higher in nonsurvivors than in survivors (P < 0.001). Multiple regression analysis showed that both intermediate and high lactate levels were independent risk factors for mortality. Patients with a high lactate level had an odds ratio (OR) of 1.81 (95% confidence interval [CI] 1.12–2.91; P = 0.015) relative to patients with a low lactate level. Patients with an intermediate lactate level had an OR of 1.73 (95% CI 1.07–2.79; P = 0.025) relative to patients with a low lactate level. Other independent predictors of mortality included Acute Physiology and Chronic Health Evaluation II score, existence of malignancy, and thrombocytopenia. Conclusion: An admission arterial lactate level of 2.0 mmol/L or higher at the time of ICU admission can be used to identify high-risk surgical patients.
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